System for maintenance and management of health

ABSTRACT

The present invention relates to a Mobile Tele-Medical Maintenance system (MTMM system) that applies different IT methods to perform different functions for the tele-medical maintenance of large numbers of individuals. The MTMM system includes a system kernel residing on web servers, linked to a large number of peripheral units on the individuals. The kernel contains a collection of all the “Private Medical Web Sites” and “Personal Health Plans” of the individuals. The MTMM system periphery includes walk-in care offices and intelligent physiological sensors that can communicate directly with the kernel&#39;s programs via the Internet or similar communication networks, preferably using the user&#39;s phone and its traditional interfaces, message display plus message voice, and push-button plus voice input. The system kernel controls the actuators directly in the periphery and uses message display and message voice output of the telephone to interact with the individual.

FIELD OF THE INVENTION

The present invention relates generally to systems for maintenance andmanagement of health for individual patients including CommunicationSystems for remote monitoring and controlling of large collections ofindividuals, persons or devices, and is also related to ArtificialIntelligence for managing and maintaining the patient's good status andtrouble-free health.

BACKGROUND OF THE INVENTION

In most western societies, namely the United States and Europe, morethan 30% of the population have serious chronic health problems thatchallenge them in many aspects of their daily lives, especially whenthey are working, traveling, or playing sports. The annual medical costin the U.S. has soared to more than $10,000 per person with healthproblems. To lower and control these costs, home and preventivehealthcare programs have been launched and promoted by insurers andpoliticians that are delivered by mostly small local caregivers atdifferent locations in the country. The success of these programs wasexpected to be significant, especially when modern tools and methods ofcommunication were designed, as described in earlier patents, fordifferent, interactive and interesting hardware systems and electronicdata processing, or, EDP methods.

But all these efforts do not escape the fact that life expectancy hasclimbed faster than any corrective measures. Sooner or later we willnearly all be a part of the group of persons who have to be constantlymonitored. In these modern societies we mostly live on our own with noother person in the home. Also, many retired people's homes will onlyaccept us if we can still move around freely and do not have to stay andbe served in bed all the time, because the next weakness or dizzinesscannot be predicted or immediately assessed and reacted upon.

Many tele-medical systems have been designed and described in detail,but they have not really been widely used and have not contributed tosuccessful optimization of costs and services. The main reason for thisis the limited use of existing technology in hardware and software bymedical caregivers and therefore only a limited range of services areconceived and delivered.

SUMMARY OF THE INVENTION

An object of the invention is to provide a system for the maintenanceand management of health which permits easy and complete access to allimportant data of the patient to be treated. The system comprisescondition monitoring devices that measures physiological data of apatient; a supervision device that assesses the measured physiologicaldata and transmits alarm signals and event information to caregivers; anevaluating device that compares problems and patterns of the measuredphysiological data and provides the caregivers with recommendedcorrective action; and a communication system that transmits alarms andrecommendations to a supervisor.

The main advantage of the system according to the present invention isthat all important data can be retrieved immediately at any location sothat caregivers such as doctors and emergency services personnel canimmediately decide which treatment or therapy to give.

Systems used for the management of large industrial plants such as thoseused to control and maintain large oil refineries, or to monitor remotepump stations along pipelines have been known for 20 year. Such systemsutilize the latest sensor technology with high-speed communications andextensive Artificial Intelligence in central supervision stations.Repair and preventive maintenance costs have been reduced to the lowestoptimized levels, while availability of very complex plants hasincreased and can be guaranteed today to 100% over 30 years.

The functions to be implemented in an efficient and optimized healthmaintenance system of large groups for individuals, spread over ruralareas, are very similar to management systems that secure the safe andefficient operation of all the installations in a large metropolitansubway system. The medical maintenance system according to the presentinvention combines the advantages of standard medical sensors andwell-trained medical personnel in hospitals, doctor's offices,wide-spread walk-in clinics, and emergency services with the leadingtechnical maintenance intelligence with the most efficient and mostwidely used traditional communication tool, the telephone.

These and other advantages of the invention are disclosed in thefollowing description in which an exemplified embodiment of theinvention is described with respect to the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows an overview of the elements of a health maintenance andmanagement system of the present invention;

FIG. 2 shows a basic program module of the inventive health maintenanceand management system for monitoring and supervising;

FIG. 3 shows another module of the inventive health maintenance andmanagement system for assessment and decision making; and

FIG. 4 shows several medical sensors connected to a mobile telephone forcommunication with the inventive health maintenance and managementsystem.

DETAILED DESCRIPTION OF THE INVENTION

In the following description, ‘patients’, ‘individuals’ and ‘units’ aredefined as the individuals and the large number of distributed entitiesto be monitored, managed and maintained. They all have a ‘condition’,which is defined by the physiological data and is measured throughdifferent parameters. The term ‘walk-ins’ refers to the devices,doctor's offices and labs, that measure and collect the ‘condition’ datafrom the ‘patients’ by ‘sensors’and feed the measured data into thehealth maintenance and management system.

The system's programs are referred to as ‘managers’. The terms‘supervisors’ and ‘caregivers’ refer to the persons in charge of the‘condition’ monitoring such as doctors and emergency services personnel.The ‘supervisors’ and ‘caregivers’ react on ‘events’, which are definedas alarms, problems and the like. ‘Resources’ are defined as the manhours, money, people, devices, energy, and consumables or disposablesused and spent for treating, troubleshooting, assisting, teaching, andmaintaining the ‘units’.

‘Logs’ are defined as all the electronically organized and recordedinputs of the measurements, actions, notes, and results. ‘Reports’ aredefined as all the information gathered over time and compiled fordifferent purposes to satisfy general and specific information needs,such as administrative functions, strategic fact-finding, anddecision-making.

MTMM System Overview

In FIG. 1, a platform of the Mobile Tele-Medical Maintenance System(MTMM) is depicted. The MTMM is a computer system that combines proventechnology process control modules, hardware and software with a knownmedical knowledge base, linked via the Internet 10. The telephone isused as a communication net and backbone to the distributed peripheralentities. The system kernel consists of several large databases 11containing all the relevant data of all the patients and resources. A‘Personal Medical Web Site’ containing the data in the form of an EMR(‘Electronic Medical Record’) is stored in a condition log in one of thedatabases 11. Access to the EMR can be obtained via an Internet link.The system kernel, which normally resides on web servers is also linkedto a large number of peripheral units on the individual patients.

A ‘Personal Health Plan’ shows all the doctor's prescriptions andrecommendations to the patient, including the patient's medication,diet, physical activities, lifestyle, the Patient's telephone calls tothe doctor's office, etc. A selected condition monitoring containsthreshold values or limits and indications for corrective actions thatare available to caregivers should any values or limits be exceeded.

A further database 12 collects all the condition measurements made andevent messages received, together with all the corrective actions orreactions taken and initiated by the manager programs, the supervisorsand caregivers, and links them to the cases, users and resources in aShift Log. The Personal Health Plan is also linked to the Shift Log. Thedatabases 11 and 12 are connected by and communicate with each otherover an internal network or intranet 13, directed by manager modules 14,supervisors, and caregivers 15.

The kernel is surrounded by peripherals linked to the databases and theManager Modules via the Internet. The peripherals include all thepatients, shown as ‘mobile hearts’ 16, the walk-ins 17, the caregivers18 and emergency services 19. These peripherals have many ways to entertheir condition data into the databases using, for example, smartSensors, lab instruments, PC's, alarm buttons, or help-phones. They mayalso enter the condition data into the database by manually typing or byvoice inputting the plain text on a terminal. Also, scanners can be usedto enter handwritten information into the databases 11, 12. Theinformation can be transposed into machine-readable information by aknown transposing program and transferred to databases 11, 12.

Log Manager Module

In FIG. 2, a Log Manager Module is shown. The Log Manager Module thebasic program module of the MTMM system, and performs conditionmonitoring and supervision. All conditions, such as measurements, alarmsevents 21, and other inputs, are entered and logged into the databases.All the necessary links 22 to the Personal Health Plans are updated,which enables fast retrieval and augmentation of knowledge stored in aknowledge database.

The Log Manager Module is a condition monitoring device that may assessthe data entered. If the patient's preset limits or trends 23 areexceeded, the module automatically generates alarms 24 to supervisors,caregivers, patients, emergency services, and other medical personnel onduty. Based on the doctors' prescriptions 25 and case classifications23, the Log Manager Module initiates telephone calls by doctors, visitsby caregivers, medication changes by pharmacies, device exchanges, andmaintenance by technicians, etc.

The Log Manager Module also sends orders 26 for these corrective actionsto the human shift supervisor, who may then decide on priorities and maycoordinate the actions. The Log Manager Module keeps track of all therelated events, such as the module's own actions and initiations, thesupervisor's decisions, the actions and the results feedback 27, in afully integrated shift log 28. It is a main characteristic of the MTMMsystem that all the tasks either can be or must be executed in parallelby the software manager modules and the human supervisors.

The Log Manager Module is an excellent tool for any shift supervision 29and for medical supervision. No handwritten notes are necessary becauseall important events are always present in the module and can be calledupon directly on-screen. The planning of shifts in care giving,emergency telephone services, for ambulances, and for hospitals, etc.becomes easier to manage.

Diagnostic Manager Module

FIG. 3 shows the Diagnostic Manager Module as an evaluating device,which is a ‘knowledge driven brain’ of the MTMM system. The moduleassesses the conditions and events, takes decisions, and makesrecommendations to the caregivers and the patients for troubleshooting,and treatment, and keeps records of the results 35 of each action.

In response to the alarms 31, condition measurements 32, anddescriptions 33 of problem situations, the Diagnostic Manager Moduleenables supervisors, caregivers, emergency technicians, and patients toassess the situation 34 and to identify the appropriate correctiveaction quickly and accurately. This module, by applying standardsoftware technologies, combines the actual ‘best-practice’ diagnosisguidelines with a unique knowledge database from electronic Shift Logs36, while learning and acquiring new knowledge 37 continuously.

With this knowledge always recallable from the Diagnostic ManagerModule, all the supervisors, caregivers, emergency and shift staff arelearning continuously while they are on their jobs 38, reducingsignificantly the cost of training while improving the quality of theirservices. Internet-based teaching can be included, linked, and added tothe recommended procedures.

Health Plan Manager Module

A Health Plan Manager Module functions as the first program in the‘Maintenance Control Cycle’. The module enables the Caregivers totailor-make their ‘teaching and treatment’ services to the patients'individual needs, while optimizing the deployment of their resources andreducing costs. This module is also the follow-up program that enablesthe caregiver and the patient to adjust their efforts and to optimizethe deviation of the condition from the accepted ‘best practice’standards for the patient's sex, age, population group, job, education,activity, etc.

All teachings, treatments, medications, activities, and conditionmonitoring parameters associated with the devices and actions aremanaged and displayed to the caregivers and patients in a PersonalHealth Plan (or Disease Management) classification system. All thedifferent sources of services (doctors, walk-ins, caregivers visits) andthe care and assistance given, both planned and unplanned, are selectedand implemented in this ‘Personal Health Plan’. For this task, theHealth Plan Manager Module draws on the caregivers' experience, the‘best-practice’ guidelines, and also on all company internal rules, andISO certified standards.

The ‘Personal Health Plan’ keeps the overall picture of all the serviceefforts performed and the resulting condition, which is summarized intoan integral history of the patient's health. Transitions in a patient's‘medical life’, such as visiting the hospital, entering into a nursinghome, moving to a different area, changing family doctor, changing job,and acquiring new health insurance, etc., can be managed withouttransferring the patient's data in a old-fashioned, cumbersome way. Inthe MTMM system, the ‘Mobile Patient’ can really leave home ‘without it’and be able to access his ‘Private Patient Web site’ and his ‘PersonalHealth Plan’ from any location in this world, while still being able tobe monitored, supervised and assisted as if he were in his hometown.

Service Manager Module

The Service Manager Module is designed for the caregiver's logisticsorganization. The module allows the caregivers to monitor and optimizetheir highly complex, distributed and costly operations. It manages thecollection of all service contracts and doctors' prescriptions. It alsocontrols all the preventive care and unscheduled troubleshooting events,by including the events in an “integral” care cycle. In addition, themodule allows regular preventive care work to be scheduled, planned,ordered, and monitored down to the smallest consumable needed.

All services, devices, and resources are recorded and managed in a partsclassification system. This system includes all necessary informationabout suppliers, contracts, equipment and warranties. Like the way theHealth Plan Manager Module manages all the patients, planned orunplanned care and peripheral entities, the Service Manager Module alsomanages and maintains the devices and resources ready for use. For thispurpose, the Service Manager Module also contains all the informationrelating to ISO standards and company internal rules and specifications.

While the caregivers perform their work, all data about the type ofservice, the methods used to solve the problems, the type and the costof the medication and material used are entered into the module and aspecial care service report is generated. Findings, conclusions, andactions taken are then transferred to the Diagnostic Manager's knowledgedatabase.

Report Manager Module

The Report Manager Module is the evaluation and analysis program for themanagement of this fully integrated health maintenance process. Itenables continuous and periodical monitoring and classification of theactivities in the electronic Shift Log, in the service orders, and inthe other events. This module gives a clear picture of the patients andthe population group's proneness to problems as well as the costcontrol, hours spent, and medication and consumables used.

The Report Manager Module also enables monitoring of the compliance ofthe therapies implemented and the outcome of the therapies administered.It therefore delivers a basis for all measures to improve efficiency andquality of the caregiving process (‘teaching and treating’) throughoutthe whole service industry and its market.

All the databases are of the relational type, based on standardsoftware. It is therefore easy to add report generators to createadditional, custom made reports, as well as to implement interfaces tosophisticated Management Information Systems.

Peripherals Integration

In FIG. 4, the integration of peripherals is depicted. The MTMM systemuses the open architecture of the Internet, the telephone and the socalled ‘RF-Piconet’, to finally enable a full integration of all typesof peripherals via the easy to use and omnipresent wired or wirelesstelephone link.

The telephones, mainly the new mobile phones, (also built into otherdevices, such as watches and palm PC's), shall become the preferreddevices to use in personal medical condition monitoring systems.Installing and assigning new peripherals is easy: new users receivetelephones with a world-wide private number (=device address). Thesetelephones can be used anywhere with any telecom company'sinfrastructure.

These new mobile phones have become real Internet terminals, with whichhuge amounts of information can be downloaded and displayed, ifnecessary. The mobile phones are used in the MTMM system as hubs for thevery small network of different intelligent sensors, called “Piconet”43, located on the patients' body and in devices nearby at home. Themobile phone can poll, display, pre-assess, and transmit the conditiondata from the sensors to the databases in the kernel. Users have longbeen comfortable with the telephone's user-friendly guidance system of:“if you need assistance, press 0”, and will also get used to high-techvoice input and voice recognition technology.

In most urban areas, the mobile phone system enables accurate trackingof the patient's position with an accuracy of approximately 50 meters,which is not only an ideal tool for any emergency medical servicepersonnel, but also for caring friends and family members.

The sensors have become ‘intelligent’ and can communicate over the sameInternet with the central Log Manager Module. In the MTMM system, thesensors can download requests and limits for bio-signal acquisition andtransmission, and perform the condition monitoring. The sensors canperform basic pre-assessments of the bio-signals and can set off localalarms to the patient, if threshold limits of the bio-signals areexceeded. The sensors integrate RF-Piconet transceivers (like Bluetooth)which enable them to start communication with any other device, wheneverthey are switched on.

The MTMM system thus performs the functions of “CSACT”: Conditionmonitoring, Supervision, Assessment, Communication, Treatment andTeaching. The system applies different methods of signal analysis in theintelligent sensors and in the kernel to assess the actual status ofindividuals. The system communicates the assessment to diagnosingprograms and supervisory personnel, and commands the actuators, theassistance personnel, and the individual patient to treat himself orherself while coping with the actual situation. Using standard andArtificial Intelligence software, the MTMM system will also perform thefollowing functions: Alarms, immediate corrective actions, reports, andlogs including accounting, recalls to care providers, optimized plansfor preventive check-ups and care, optimized management of allpersonnel, material, devices and infrastructure resources of thecaregivers, and provide all sorts of statistics for any level of themedical hierarchy in political, public, and private health organizationsand insurers.

FIG. 4 shows a typical ‘Piconet’ 43 in the MTMM system, having a mobiletelephone 41 with display 42, special display control buttons 44,numeric keypad 45 for typing in values from stand-alone tests, andspeaker and microphone for voice output and input 46. The mobiletelephone 41 communicates with any server on the Internet and itsbuilt-in RF-Piconet transceiver 47 communicates with two sensors on thepatient's body and one tabletop device.

A heart monitor 50 senses the ECG with two electrodes 48, pre-analyzesthe ECG and stores it on a memory-card 49. The heart monitor alsomonitors the breathing rate and volume by breath sensors 52. Themeasured values are stored and checked for coherence between twonormally independent signals. The heart monitor 50 uses the display 42of the mobile telephone 41 to show the patient locally his condition,such as with heart-rate, body temperature, breathing rate arid breathvolume. The mobile telephone 41 further transmits the condition dataover the Internet 53 to the MTMM system and to its Log Manager Module.The heart monitor 50 and mobile telephone 41 may communicatecontinuously or periodically with each other, only in case of alarms, orin cases when limits are exceeded.

The system has a non-invasive blood pressure unit, 55 which is used onlya few times a day according to the doctor's request. Like many otherdevices; whenever the unit is taken out of the pocket and switched on,it automatically searches via transceiver 47 the area for an active‘Piconet’ to connect to. The RF-Piconet transceiver 47 (like Bluetooth)offers this type of network, similar to the wire-bound Ethernet.

An old fashioned strip-type glucose meter 56 may be used with thesystem. The built-in RF-Piconet transceiver 47 will automatically callthe MTMM system via the mobile telephone's access to the Internet 51 andwill request the condition measurement schedules. If it does not havethe network capability, the MTMM system will request the patient, viathe mobile telephone's display 42, to perform a measurement at theprescribed time and to type in the resulting value via the numerickeypad 45 of the mobile telephone 41. It should be clear to the skilledperson that instead of mobile telephones, 41 normal telephone sets orPC's with a monitor can also be used.

Built-in data conversion modules in the Log Manager Module allow definedalarms and condition data formats to be transferred directly into thesystem database. The supervisors can assess the individual patients'status in ‘real-time’ by calling their mobile phone's “Piconet” hub.

Also, the devices leased and maintained by the caregiver, ambulancepersonnel, and medical personnel can be called and directed in‘real-time’. The logs of their deployment are transferred, at the sametime, to commercial bookkeeping and invoicing systems within thecompany, offering useful and efficient support that are not found inother systems.

Standard Hardware and Software

The system is standard-based, and runs on Windows and Unix platforms.The databases are all relational. The system is also modular. Theindividual modules can be used independently of one another.

The preferred network, fully exploiting the new WAP (WirelessApplication Protocol) capabilities, is the worldwide Internet, or anIntranet in large companies, hospitals, nursing home facilities, etc.The mobile telephone can control several sensors and input devices. Inaddition, the Bluetooth network is the future standard inthese“Piconets”.

What is claimed is:
 1. A system for maintenance and management of healthfor large numbers of individual patients, the system comprising: (a) acondition monitoring device, having alarm signals, that measuresphysiological data on a patient, and transmits, enters, and stores thedata as event information of the patient into a Condition Log; (b) asupervision device that assesses the alarm signals and eventinformation, wherein the supervision device transmits the alarm signalsand event information to caregivers, allowing the caregivers to initiatea corrective action on the patient and to request a report about thecorrective action and its results, the report being entered and storedinto a Shift Log; (c) an evaluating device, that evaluates problems andpatterns of measurements by comparing the problems and patterns withaccumulated information in a knowledge database, wherein the evaluatingdevice thereafter selects the appropriate corrective action to berecommended to the caregivers, requests a report of the caregivers aboutthe corrective action and its results, and enters the report into theknowledge database, whereby the knowledge database accumulates andenlarges, and; (d) a communication system that connects to a system fortransmitting alarms and recommendations to a supervisor, whereby thesupervisor corrects and releases the alarms and recommendations, and thealarms and recommendations are transmitted further to the caregivers forperforming a recommended action.
 2. A system according to claim 1,wherein the communication system further comprises at least one devicefor Internet access.
 3. A system according to claim 1, wherein thecommunication system further comprises at least one sensor for measuringthe physiological data on the patient.
 4. A system according to claim 1,wherein the system further comprises a Medical Web Site, the Medical WebSite containing a separate database containing all medical data and amedical history of each individual patient, the database beingaccessible by the patient and the caregivers.
 5. A system according toclaim 1, wherein the system further comprises a Personal Health PlanManager Module, the Personal Health Plan Manager Module being attachedto monitored data, compliance for therapies, and outcome of thetherapies, and wherein the Personal Health Plan Manager Module isaccessible by the patient and the caregivers.
 6. A system according toclaim 1, wherein the system further comprises a Log Manager Module, andwherein the Log Manager Module monitors the alarm signals and the eventinformation in the Condition Log and supervises the reports in the ShiftLog.
 7. A system according to claim 1, wherein the system furthercomprises a Diagnostic Manager Module, wherein the Diagnostic ManagerModule diagnoses the condition of the individual patient by comparingdata stored in expert computer programs containing diagnosis guidelinesto the accumulated data of the knowledge database.
 8. A system accordingto claim 2, wherein the communication system contains at least onedevice selected from the group consisting of: Internet accessible mobiletelephones, personal digital assistants, and personal computers.
 9. Asystem according to claim 5, wherein the Personal Health Plan ManagerModule contains a type of data selected from the group consisting of:doctor's prescriptions for medication; treatments, practices, andlifestyles of the individual patient; a schedule for the monitoring ofconditions stored in the Condition Log; selection of sensors to be used;threshold values of the physiological data to be monitored; andcorrective actions.